Among the most widely attended sessions at the 2016 Palliative Care in Oncology Symposium in September was the keynote lecture, “Wit, Hex, Vin, Life, Death: Using Wit as a Teaching Tool,” given by Margaret Edson, author of the Pulitzer Prize–winning play Wit.Wit tells the story of an accomplished English Professor Vivian Bearing, an authority on 17th century English poetry, specifically the Holy Sonnets of John Donne, who is diagnosed with stage IV ovarian cancer and is facing months-long aggressive, experimental chemotherapy and is forced to reassess her life. Beyond cure of her cancer, Wit is not a story of survival but rather of personal redemption and humanity.

During her keynote lecture, Ms. Edson showed scenes from the Emmy Award–winning 2001 film adaption of the play, which she said could be used as a teaching tool to help physicians become better listeners and more empathetic clinicians. In fact, the film is being used in several medical schools throughout the United States and Canada to advance education in end-of-life care. (HBO has made the film available for free on YouTube at www.youtube.com/watch?v=u0PPvYlGqL8.)

Many of the medical details in Wit are based on Ms. Edson’s experience working as a unit clerk on an AIDS and cancer ward in a research hospital in Washington, DC, while attending graduate school in the mid-1980s. Although the play has garnered many honors in addition to the Pulitzer Prize, including the Drama Desk, Dramatists Guild, New York Drama Critics’ Circle, and Outer Critics Circle, among others, and received high praise from drama critics, Ms. Edson has never written another play, preferring instead to devote her time to making a contribution in the classroom. A public school teacher for 25 years, Ms. Edson is currently teaching social studies to middle school students in Atlanta.

The ASCO Post caught up with Ms. Edson on her day off to talk about how art can be used to bring humanity to the practice of medicine.

Inspiring Experience

What was it like to address hundreds of oncology professionals during the 2016 Palliative Care in Oncology ­Symposium?

It was inspiring for me to be talking to people who work so hard and have so much skill, talent, and compassion. I felt lifted to a very high level by the quality of attention in the room.

Never Stopped Teaching

Wit was your first and only play. Why haven’t you written another play?

The contribution I want to make now is in my classroom. I never stopped teaching after I wrote Wit, so I kept doing the work I felt like doing. When I wrote Wit in 1991, it was an idea I wanted to work out in that medium, and the ideas I want to work out now I’m working out in my classroom.

Impetus for Wit

Did the impetus for writing Wit grow out of your experience working as a unit clerk on a cancer and AIDS floor in a research hospital?

Yes and no. I worked in the hospital because I wanted to do that work and loved it; I felt so proud to come to the end of the day and realize that everything I had done was to help somebody else. I felt so useful. To have a job that was the embodiment of service to others was really inspiring and challenging, because it was a difficult job and I was really young. It was also very nurturing, and the experience set my mind toward working in a service profession.

Technically Precise Language

Did working at the hospital give you the technical language and the kind of patient awareness that you used so well in the play?

That wasn’t my intention when I was working there, but that is what happened. When I sat down to write my play, I decided to place it in an oncology inpatient unit of a research hospital, and all the medical details were things I remembered from my work in the hospital, so I was able to get the writing as technically precise as I possible could.

We have to remind ourselves that speaking
clearly is not the same thing as being
understood by the audience listening, and that’s true in every profession.

— Margaret Edson

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In addition to drawing on that experience, I also did hours and hours of research and then took the play to one of the nurses I had worked with and asked her to read it over to make sure the details were correct. I wanted the play to be very precise in its ­language.

Professor Bearing’s Transformation

What is the lesson you are trying to show in Wit?

I’m trying to show one person discovering her true self, and that was a scary thought for Professor Bearing, because she was the world’s expert in everything and now has a terminal cancer diagnosis and has to come down from her high horse and be open to learning in a new way that she wouldn’t have foreseen for herself. And she is so broken down physically from the treatment, she is wide open emotionally and in her interior life, which transpires gradually over the course of the play.

Although she fights the experience every step of the way, in the end she becomes not a new person, but a real person. She becomes her true self. The audience has a vague sense that something is going to happen, but they don’t know what, and by the end of the play they see Professor Bearing’s transformation. She is not cured of her cancer, and we never thought that she would be, but she is made whole in a new and interesting way.

A Teaching Tool

How can oncologists use Wit as a teaching tool in their practices?

I was interested in chatting with people attending the Palliative Care in Oncology Symposium and found that almost everyone there teaches in some way; that was surprising to me, because in a lot of other professions, people working at a very high level are not involved with teaching. But everyone I talked to has students following him or her around, and I liked that and felt so comfortable being at the conference.

What I encourage people to do with my presentation is instead of watching the film straight through and then discussing it with their medical students, it would be more productive to slice it up into segments and concentrate on the moments that really serve students’ learning goals at a certain moment in their medical education.

In my presentation at the symposium, instead of shoving the key scenes down people’s throats, I stopped the film at specific scenes I thought were useful to use as a clinical teaching tool to present a patient case history in a way that gives the teacher complete control as to how much information to present during each lesson.

Being Understood

In your presentation, you talked about how the hard part of writing is listening to your characters. Is that the lesson for oncologists as well: to listen to their patients and to recognize that patients often aren’t hearing or interpreting correctly what oncologists are saying?

That problem is not unique to medicine. I’m yammering away all the time in my class, and who knows how much of the information my students are actually absorbing. We have to remind ourselves that speaking clearly is not the same thing as being understood by the audience listening, and that’s true in every profession.

In the film and in the play, the doctor perfectly explains the seriousness of her cancer to Professor Bearing. Then as she experiences the information from her point of view, the audience doesn’t hear a word the doctor is saying because they are so caught up in her reaction to what she is experiencing.

Awareness of Listening

How can Wit help oncologists be more empathetic and recognize the importance of treating patients the way they would want to be treated in a similar ­circumstance?

Learning to be more empathetic is not exclusive to the field of oncology. What art does is it gives us a chance to use our imaginations to experience what others are going through, and the more we are able to imagine the experience of another person, the more meaningful our relationship with that person is going to be.

I don’t at all presume to tell oncologists how to do their job, but as a human being and as a person who communicates all day long to 12-year-olds, I’m always striving to hold in one hand what it is I’m trying to convey and in the other hand my awareness of the experience of my listeners.

Surprising Scene

At the end of the play, there is a jarring scene of a young physician who disregards Vivian Bearing’s do-not-resuscitate directive and begins to resuscitate her over the protestations of other medical staff. Is that another lesson for oncologists, to accept a patient’s wish for his or her end-of-life care?

The physician is a research fellow, and the play doesn’t explain why he takes the action he does to resuscitate Professor Bearing. I set the scene in motion, but it’s the job of the actor and the director to prove the meaning of what is taking place. If that scene were to be used as a teaching tool for medical students, it would be up to the person leading the class to discuss what the motivation of the physician’s actions might be.

The ending of the play is a bit different from the film version. In the live performance, when Professor Bearing codes and dies, she gets out of the bed and walks across the stage and leaves the medical staff to their resuscitative efforts. She takes off her cap and lets it drop to the floor; then she takes off her gown and stands there completely naked. In that moment, she is opening herself to the audience and to the world and to her life, and there is nothing between her and her truth.

It’s a big, brassy theater moment and is not well suited to the quiet introspection of the film. But that scene takes everybody by surprise. I didn’t see it coming when I was writing it, and Professor Bearing certainly didn’t see it coming, but there it is. ■